This document discusses iatrogenic disorders, which are adverse effects caused by medical diagnostic and therapeutic procedures. Some key points:
- Diagnostic procedures like imaging with contrast dye and biopsies can cause side effects ranging from mild reactions to death.
- Therapeutic regimens, especially multiple drug prescriptions, increase the risk of adverse drug reactions in patients. When 15 or more drugs are prescribed, the risk of adverse reactions increases to over 20%.
- Adverse drug reactions can affect many body systems and organs. They include cutaneous issues, blood disorders, gastrointestinal problems, respiratory conditions, cardiovascular disease, and renal failure.
- The elderly are more susceptible to adverse drug reactions due to age
Pranavata initiates impulse from Shirasa (Buddhi Hrudayendriya chittam – druk = aspect) travels through nose, tongue, pharynx, neck till Uras understood as – reticular formation form the Medulla oblongata with higher center connected especially “Respiratory center”
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
Sandhigata Vata is the type of pathogenesis involved in various disease conditions affecting the joints, e.g. osteoarthritis, rheumatoid arthritis, etc. and causing pain in affected joints.
Pranavata initiates impulse from Shirasa (Buddhi Hrudayendriya chittam – druk = aspect) travels through nose, tongue, pharynx, neck till Uras understood as – reticular formation form the Medulla oblongata with higher center connected especially “Respiratory center”
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
Sandhigata Vata is the type of pathogenesis involved in various disease conditions affecting the joints, e.g. osteoarthritis, rheumatoid arthritis, etc. and causing pain in affected joints.
Swasa Roga is a typical respiratory problem mentioned in classical Ayurveda texts. This presentation has tried to include classical as well as modern perspectives of respiratory problems that has difficulty in breathing/dyspnoea as the major symptom.
Gridhrasi is defined as Stambha (stiffness), Ruk (pain), Toda (pricking pain) in a radiating manner along with Spandana (tingling sensation) starting from Kati Pradesha (low back) to Prushtha (back), Janu (knee joints), Jangha (calf muscles) and Pada (dorso lateral aspect of feet) of either one side of the lower limb or may involve both lower limbs. This condition makes raising of the affected leg difficult.
Ayurvediy Conservative Management of Parikartika Fissure in Ano A Case Studyijtsrd
Parikartika as the name suggests is the ano rectal disease explained in Bruhatrayees in which there is a pain like cutting with Axe in the Anal and perianal area. Nowdays, due to unhealthy lifestyle, irregular food habits, disturbed sleep pattern many people are suffering from many digestive issues like indigestion, acidity, constipation etc. It is common in working individual as well as homemakers. Constipation results in hard stool passage, which results in longitudinal tear in the lower end of anal canal results in fissure in ano. Anal fissure comprises of 10 15 of anorectal disorders and is characterized by excruciating pain during and after defecation, blood stained stool, burning sensation almost for 1 2 hours after defecation, sometime swelling. In Ayurveda Parikartika is usually described as a symptom found in other diseases like arsha, grahani, atisara, udavarta etc. or as a complication of faulty instrumentation and excessive or improper panchkarma virechan and basti procedures which produce a tear in anal region with features of cutting or tearing type of pain, burning sensation and bleeding during and after defecation. While treating Parikartika by applying ayurvedic principles one has to mainly focused on stabilizing the digestive functions and improving the nature, character, and consistency of stool in addition to the use of laxatives and wound healing vranropan agents. And on the counterpart, modern management includes chiefly Surgical interventions but the result was found to be less satisfactorily with much recurrences. That is why in this case study genuine effort made here to manage Parikartika by fully Ayurvediy approach. Dr. Rupali S. Shinde | Dr. Prasad P. Pande "Ayurvediy Conservative Management of Parikartika - Fissure in Ano - A Case Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-4 , June 2022, URL: https://www.ijtsrd.com/papers/ijtsrd50237.pdf Paper URL: https://www.ijtsrd.com/medicine/gynecology/50237/ayurvediy-conservative-management-of-parikartika--fissure-in-ano--a-case-study/dr-rupali-s-shinde
general debility for BAMS final year
brief information about general debility, causes, symptoms and management
ayurveda correlation of general debility, causes , management including ahara, shamana oushadha, rasayana and chikitsa upakrama
murivenna has been a formulation used in Ayurveda since a longtime.with its origin in the siddha system ,this formulation has become an inevitable component in the management of dislocations,fractures and tendon tears in the Ayurveda system. although widely used for bandaging ,this wonder drug can be administered via various other routes of administration including enema(vasti) and snehapanam.
Disease induced by/ due to the activity of a physician or therapy. For example, an iatrogenic illness is an illness that is caused by a medication or physician.
What are iatrogenic effects?
Medical error and negligence. Iatrogenic conditions do not necessarily result from medical errors, such as mistakes made in surgery, or the prescription or dispensing of the wrong therapy, such as a drug. In fact, intrinsic and sometimes adverse effects of a medical treatment are iatrogenic.
What is social Iatrogenesis?
Medicalisation is associated with a social process that Illich termed 'iatrogenesis'. This concept refers to the detrimental consequences of medical interventions (clinical iatrogenesis), such as adverse drug reactions and hospital acquired infections.
Swasa Roga is a typical respiratory problem mentioned in classical Ayurveda texts. This presentation has tried to include classical as well as modern perspectives of respiratory problems that has difficulty in breathing/dyspnoea as the major symptom.
Gridhrasi is defined as Stambha (stiffness), Ruk (pain), Toda (pricking pain) in a radiating manner along with Spandana (tingling sensation) starting from Kati Pradesha (low back) to Prushtha (back), Janu (knee joints), Jangha (calf muscles) and Pada (dorso lateral aspect of feet) of either one side of the lower limb or may involve both lower limbs. This condition makes raising of the affected leg difficult.
Ayurvediy Conservative Management of Parikartika Fissure in Ano A Case Studyijtsrd
Parikartika as the name suggests is the ano rectal disease explained in Bruhatrayees in which there is a pain like cutting with Axe in the Anal and perianal area. Nowdays, due to unhealthy lifestyle, irregular food habits, disturbed sleep pattern many people are suffering from many digestive issues like indigestion, acidity, constipation etc. It is common in working individual as well as homemakers. Constipation results in hard stool passage, which results in longitudinal tear in the lower end of anal canal results in fissure in ano. Anal fissure comprises of 10 15 of anorectal disorders and is characterized by excruciating pain during and after defecation, blood stained stool, burning sensation almost for 1 2 hours after defecation, sometime swelling. In Ayurveda Parikartika is usually described as a symptom found in other diseases like arsha, grahani, atisara, udavarta etc. or as a complication of faulty instrumentation and excessive or improper panchkarma virechan and basti procedures which produce a tear in anal region with features of cutting or tearing type of pain, burning sensation and bleeding during and after defecation. While treating Parikartika by applying ayurvedic principles one has to mainly focused on stabilizing the digestive functions and improving the nature, character, and consistency of stool in addition to the use of laxatives and wound healing vranropan agents. And on the counterpart, modern management includes chiefly Surgical interventions but the result was found to be less satisfactorily with much recurrences. That is why in this case study genuine effort made here to manage Parikartika by fully Ayurvediy approach. Dr. Rupali S. Shinde | Dr. Prasad P. Pande "Ayurvediy Conservative Management of Parikartika - Fissure in Ano - A Case Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-4 , June 2022, URL: https://www.ijtsrd.com/papers/ijtsrd50237.pdf Paper URL: https://www.ijtsrd.com/medicine/gynecology/50237/ayurvediy-conservative-management-of-parikartika--fissure-in-ano--a-case-study/dr-rupali-s-shinde
general debility for BAMS final year
brief information about general debility, causes, symptoms and management
ayurveda correlation of general debility, causes , management including ahara, shamana oushadha, rasayana and chikitsa upakrama
murivenna has been a formulation used in Ayurveda since a longtime.with its origin in the siddha system ,this formulation has become an inevitable component in the management of dislocations,fractures and tendon tears in the Ayurveda system. although widely used for bandaging ,this wonder drug can be administered via various other routes of administration including enema(vasti) and snehapanam.
Disease induced by/ due to the activity of a physician or therapy. For example, an iatrogenic illness is an illness that is caused by a medication or physician.
What are iatrogenic effects?
Medical error and negligence. Iatrogenic conditions do not necessarily result from medical errors, such as mistakes made in surgery, or the prescription or dispensing of the wrong therapy, such as a drug. In fact, intrinsic and sometimes adverse effects of a medical treatment are iatrogenic.
What is social Iatrogenesis?
Medicalisation is associated with a social process that Illich termed 'iatrogenesis'. This concept refers to the detrimental consequences of medical interventions (clinical iatrogenesis), such as adverse drug reactions and hospital acquired infections.
Drug induced disease is defined as the unintended effect of a drug that results in mortality or morbidity with symptoms sufficient to prompt a patient to seek medical attention and/or to require hospitalization and may persist even after the offending drug has been withdrawn. Drug induced diseases also called as iatrogenic diseases, are well known but least studied entity. In this review, we have collected the information from review and research articles related to the drug induced diseases. This review is intended to aid the understanding of some basic concepts regarding the drug induced diseases. This tends to provide information about the some commonly occurring drug induced disorders, the drugs responsible for inducing disorders, their prevention and some of the treatments.
Chemotherapy induced disorders by sara ahmed yadallahPARUL UNIVERSITY
Chemotherapy is the treatment of infectious diseases or malignancy with drugs that destroy microorganisms or cancer cells preferentially with minimal damage to host tissues
Chemotherapy refers to treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
1. *
Consultant and Dean, GKNM Hospital, Coimbatore, Tamil Nadu, +
Professor and Head, Department of Medicine, Vydehi Institute of
Medical Sciences and Research Center, 82 EPIP Area, Whitefield, Bangalore.
Guest Column
Iatrogenic Disorders
Lt Gen NR Krishnan, PHS (Retd)*
, Brig AS Kasthuri, VSM (Retd)+
MJAFI 2005; 61 : 2-6
Key Words : Drug interactions; Doctor induced adverse drug reactions; Drug toxicity
Iatrogenic disease is the result of diagnostic and
therapeutic procedures undertaken on a patient. With
the multitude of drugs prescribed to a single patient
adverse drug reactions are bound to occur. The
Physician should take suitable steps to detect and
manage them.
Iatrogenic (of a disease or symptoms) induced in a
patient by the treatment or comments of a physician.
Chambers English Dictionary
One of the basic principles in treatment stated by
Hippocrates is “First do no harm”. Stories of medical
remedies causing more harm than good have been
recorded from time immemorial. An iatrogenic disorder
occurs when the deleterious effects of the therapeutic
or diagnostic regimen causes pathology independent of
the condition for which the regimen is advised. It would
be impossible to provide the benefits of modern medicine
if reasonable steps in diagnosis and treatment were
withheld because of possible risks [1]. Diagnostic
procedures (mechanical and radiological), therapeutic
regimen (drugs, surgery, other invasive procedures),
hospitalizationandtreatingdoctorhimselfcanbringabout
iatrogenic disorders.
Adverse effects of diagnostic procedures
Mechanical procedures
Diagnostic aspiration of fluids may lead to
hemorrhage, secondary infection, etc. Rapid pleural or
peritoneal fluid aspiration and needle biopsies may lead
to shock and even death. Endoscopic procedure may
cause perforation of hollow viscus.
Diagnostic radiology
Reactions to contrast media injected intravenously
or intra-arterially may be mild, moderate or severe, and
some are potentially fatal. Intravascular contrast media
may have a nephrotoxic reaction. Cerebral angiography
may cause transient or permanent neurological deficits.
Radioisotopes are safe except in pregnant mothers or in
newborn [2].
Adverse effects of therapeutic regimen
Adverse drug reactions (ADR)
ADR is defined by World Health Organization as any
response for a drug which is noxious, unintended and
which occurs at doses normally used for prophylaxis,
diagnosis and therapy of disease [3]. ADR can be
classified as predictable (side effects, toxicity, super
infection, drug interactions) and unpredictable
(intolerance, idiosyncrasy, allergy or pseudo allergy) [4].
When fewer than 6 different drugs are given in
hospitalized patients, the probability of an adverse
reaction is about 5%, but if more than 15 drugs are given,
the probability is more than 20%. Of the patients admitted
to a General hospital, 2 to 5% are due to ADR and
fatality in patients with ADR varies from 2-12%. ADR
occurs in the elderly more frequently [5].
To overcome the inadequacies in the WHO definition,
new definition for adverse drug reaction is “an
appreciablyharmfulorunpleasantreaction,resultingfrom
an interaction related to the use of a medicinal product,
which predicts hazard from future administration and
warrants prevention or specific treatment or alteration
of the dosage regimen or withdrawal of the product”.
They are classified into six types (with mneminics), dose-
related (Augmented), non-dose-related (Bizarre), dose-
related and time-related (Chronic), time-related
(Delayed), withdrawal (End of use), and failure of
therapy (Failure) [6].
Anaphylaxis
Penicillin and other Beta-lactum antibiotics and
various types of vaccines and sera, and human insulin,
are the most common agents that cause anaphylaxis.
Aspirin and other nonsteroidal anti-inflammatory agents
(NSAIDs) cause non-IgE mediated anaphylactoid
reactions [7].
2. MJAFI, Vol. 61, No. 1, 2005
Iatrogenic Disorders 3
Drug induced cutaneous manifestations
Some of the cutaneous manifestations are [8]:
1. Alopaecia Cytotoxic agents
2. Erythema multiforme Chlorpropamide,
Sulphonamides
3. Exanthematous eruptions Allopurinol,Anti
convulsants
4. Exfoliative dermatitis Gold, streptomycin
5. Fixed drug eruptions Barbiturates,
Tetracyclines
6. Photosensitivity Griseofulvin,
Indomethacin
7. Toxic epidermal necrolysis Barbiturates,
Sulphonamides
Drug induced haematological disorders
Megaloblastic Anaemia (MA)
Oral contraceptives, phenytoin, phenobarbitone and
primidone cause MA due to folic acid deficiency,
colchicines, neomycin, paramino salicylic acid (PAS) due
to vitamin B12
deficiency and 6-mercaptopurine, 5 fluro-
uracil, hydroxy-urea, acyclovir and zidovudine by
interfering with DNA metabolism [9].
Hemolytic anemia
Drugs causing haemolysis by direct action are
phenacetin, PAS, sulphonamides: by immune mechanism
are aminopyrine, chlorpromazine, quinine and
tetracycline: and in G-6 PD deficient patients,
antimalarials (primaquine) and antibiotics
(nitrofurantoin) [10].
Aplastic anaemia
Drugs that regularly produce bone marrow depression:
busulphan,cyclophosphamide,chlorambucil,vinblastine,
and 6 mercaptopurine. Drugs which rarely produce bone
marrow depression: chloramphenicol, penicillamine,
sulphonamides, isoniazid, NSAIDSs, analgin, thiouracil,
anticonvulsants, anti diabetics, cimetidine, tranquilizers
etc [11].
Drugs producing Neutropenia [12]:
Analgesics and NSAIDs :Indomethcin, Phenacetin,
Acetaminophen, Phenyl-
Butazone and Aminopyrine
Anticonvulsants :Phenytoin, Carbamazepine
Antithyroid drugs :Thiouracil, Methimazole
Phenothiazines :Chlorpromazine
Antiarrhythmic :Quinidine
Drugs that cause thrombocytopaenia [12]:
Alpha-methyldopa, carbimazole, chloramphenicol,
cyclosporins, phenylbutazone, quinine, quinidine,
rifampicin, sulphonamides etc.
Hazards of blood transfusion[13]:
Complications occur in 2 percent of blood
transfusions.
a. Immunologicalreaction:Allergic-anaphylaxis,fever,
haemolysis, non cardiac pulmonary oedema.
b. Non immunological : Circulatory overload,
thrombophlebitis and embolism, bacterial
contamination, transmission of diseases like malaria,
hepatitis, syphilis and AIDS and transfusion siderosis
in multiple transfusion.
Drug induced gastro-intestinal diseases [5,7]
Oral lesions
1. Lichen planus like lesions : methyldopa, chloroquine
and propranolol.
2. Lupus erythematosis like lesions : hydralazine, gold.
Acid peptic disease : acetyl salicylic acid, NSAIDs,
corticosteroids etc.
Pancreatitis : azathioprine, glucocorticoids and oral
contraceptives.
Malabsorption : broad-spectrum antibiotics,
cholestyramine and neomycin.
Hepatic damage
Drug induced liver injury is a potential complication
of nearly every medication because liver metabolizes
virtually all drugs. Acute (acetaminophen, halothane)
and chronic (nitrofurantoin, methyldopa) hepatocellular
injury, veno occlusive disease (cyclophosphamide) and
hepatocellular carcinoma (sex and anabolic hormones)
can all occur. There are many new drugs like glyburide,
ketoconazole, lisinopril, lovastatin, ticlopidine etc. which
were also associated with hepatotoxic reactions. Among
causes of fulminant hepatic failure certain drugs like
halothane, acetaminophen, phenytoin and alpha
methyldopa account for 20-50% of cases [14].
Respiratory disorders due to drugs [5,15]:
Type of reaction Example of drug
1.Airway obstruction Beta-Blockers, Adenosine,
(Bronchospasm) NSAIDs
2.Cough ACE inhibitors
3.Nasal congestion Oral contraceptives,
Reserpine, Guanithidine
4.Pulmonary oedema Contrast media,
Methadone, Interleukin 2
5.Pulmonary hypertension Fenfluramine
6.Pulmonary infiltration Anticancer agents,
Acyclovir, Amiodarone
3. MJAFI, Vol. 61, No. 1, 2005
4 Krishnan and Kasthuri
7.Pleural disease Hydralazine, Methysergide
8.Pulmonary thrombo- Oral contraceptives
embolism
Drug induced cardiovascular diseases
Drug reactions may lead to exacerbation of angina
(alpha blockers), arrhythmias (digitals, beta-adrenergic
agents, tricyclic anti-depressants and quinine),
cardiomyopathy (daunorubicin, emetine and lithium),
hypo or hypertension (glucocorticoids and
sympathomimetics), pericardial disease (emetine,
procainamide and minoxidil), and Torsades de pointes
(sparfloxacin) [5].
Renal disorders caused by drugs [16].
The kidney is the main excretory organ of the body
and hence affected by most drugs.
1. Directly toxic to the tubular cells: paracetamol,
amphotericin B, cisplatin, sulphonamides etc.
2. Function as an antigen or as a hapten and the
resulting antigen antibody reaction damages renal
interstitium and leads to acute interstitial nephritis :
penicillins, cephalosporins, NSAIDs, anticoagulants,
gold salts, captopril etc.
3. Renal failure by reducing renal blood flow:
noradrenaline and dopamine in high doses. NSAIDs
indirectly affect renal blood flow by inhibiting
production of prostaglandins.
Analgesic nephropathy – heavy and prolonged
consumption of compound analgesic preparations
particularly those containing phenacetin can cause
chronic renal failure. This analgesic nephropathy is part
of a broader analgesic syndrome, which includes
hypertension, peptic ulcer, anaemia and recurrent
headache.
Syndrome of drug-induced kidney disease
Common risk factors which precipitate adverse
effects include old age, volume-depleted state, pre-
existing renal dysfunction and co-existing use of other
nephrotoxins.
Syndrome Drugs
1. Pre-renal failure/functional NSAIDs, ACE-
renal failure inhibitors, Diuretics,
Interleukin-2,
Amphotericin-B.
2. Acute tubular necrosis Aminoglycosides,
Rifampicin, NSAIDs,
Cyclosporine, Cisplatin
3. Acute Interstitial nephritis Penicillins, NSAIDs,
Allopurinol,Thiazides,
Sulfonamides.
4. Thrombotic Mitomycin-C,
microangiopathy/hemolytic Cyclosporine, Quinine,
uremic syndrome Cocaine, Clopidogrel.
5. Isolated proteinuria with Gold, heroin, Captopril,
nephritic syndrome NSAIDs, IFN-alpha,
D-penicillamine.
6. Chronic tubulointerstitial NSAIDs, Thiazides,
disease Lithium, Chinese herb
nephropathy,
Germanium.
7. Retroperitoneal fibrosis Methysergide,
Hydralazine,
Methyldopa.
Neurological manifestations[17]
1. Aseptic meningitis Intravenous
immunoglobulin
2. Extra pyramidal lesions Haloperidol, Methyl
dopa, Phenothiazine
3. Peripheral neuropathy Isoniazid,
Metronidazole, Gold
salts, Nitrofurantoin,
Amiodarone,
Vaccines.
4. Pseudomotor Cerebri or Amiodarone,
intracranial hypertension Glucocorticoids, Oral
contraceptives
5. Convulsions Amphetamine,
Analeptics, Lithium,
Phenothiazine
6. Stroke Oral contraceptives
7. Encephalitis and Guillain- Anti-rabies vaccination
Barre syndrome (purified chick embryo
cell)
8. Myopathy Statins
Neuroleptic malignant syndrome – Rigidity,
hyperthermia, altered mental status resembling catatonia,
labile blood pressure and autonomic dysfunction
characterize one of the serious complications of
neuroleptic agents like Haloperidol [18].
Drug induced psychiatric syndromes [5]:
1. Delirium or Confusional Anticholinergics,
state Glucocorticoids,
Phenothiazines
2. Depression Beta blockers,
Glucocorticoids,
Nifedipine
3. Drowsiness Antihistamines
4. Hallucination Beta blockers,
Levodopa, Narcotics
4. MJAFI, Vol. 61, No. 1, 2005
Iatrogenic Disorders 5
5. Hypomania, Mania Glucocorticoids,
Sympathomimetics
6. Paranoid states Amphetamines
Drug induced musculoskeletal/rheumatic
disorders[19]
Disorder Drug
1. Arthralgia Fluorides, growth hormone,
Penicillin, Quinolones (in
children), Sulphonamides
2. Hyper-uricaemia and Cytotoxic drugs,
Gout Cyclosporine, Salicylates
Ethambutol, Levodopa,
Nicotinic acid, Phenytoin,
Diuretics.
3. Mylagia/Myositis Amphotericin B,
Chloroquine, Cimetidine,
Clofibrate, Colchicines,
Cyclosporines, Gemfibrozil,
Lovastatin, Levodopa,
Penicillamine, Phenytoin,
Rifampicin, Vincristine,
Zidovudine.
4. Osteoporosis Anticonvulsants,
Corticosteroids, Heparin,
Methotrexate.
5. Scleroderma like Bleomycin, INH,
disorder Penicillamine, Silicon
Breast implants.
Adverse reactions due to sudden stoppage of
drug
Sudden stoppage of drugs can cause[20]:
a a “rebound phenomenon” : relapse with or without
exacerbation of the basic disease
b. a “withdrawal phenomenon” : a new clinical
syndrome unrelated to the original disease
Antihypertensive drugs: Sudden stoppage of clonidine
and alpha methyldopa cause syndrome resembling
pheochromocytoma.
Beta-blockers: Sudden stopping of the drug in
coronary artery disease may cause infarction,
aggravation of angina or rhythm disorders.
Corticosteroids: Withdrawal accidents are seen after
prolonged treatment, unrelated to the dose and duration
of treatment and relapse of basic disease even in an
aggravated form.
Barbiturates: Sudden stoppage in epileptic patients
can induce status epilepticus. When used to induce sleep,
sudden stoppage can cause acute insomnia, confusion,
agitation, hallucinations and convulsions.
Drugs producing malignant diseases[21]:
1. Leukemia - Anti cancer agent,
(esp. acute myeloid Radiotherapy, rarely
leukemia) Chloramphenicol and
Phenyl-butazone
2. Cancer of breast and - Estrogens, Tamoxifen
endometrium
3. Cancer of vagina - Diethyl stilbesterol
4. Liver cancer - Anabolic steroids,
Oral contraceptives
Drug nutrient interaction
Drugs may decrease nutrient absorption, increase
urinary excretion, directly compete with or antagonize
the nutrient from a carrier protein and interfere with the
synthesis of an enzyme or coenzyme essential for the
metabolism of the nutrient[22].
Drug induced fever
Drug fever constitutes one percent of all fevers of
unknown origin. Any drug can cause fever
(antihistamines, barbiturates, iodides, penicillins,
phenytoin, propylthiouracil, β-lactum antibiotics etc). A
history of allergy, skin rash or eosinophilia is often absent
in cases of drug fever [23].
Adverse reactions following immunization [24]:
1. Inherent vaccine (a) Mild and common
induced - local reaction, fever
(b) Moderately severe and
uncommon –suppurative
lymphadenitis (BCG
vaccination)
(c) Severe and rare-
Encephalopathy and
hypersensitive reactions
(paralytic polio following
oral polio vaccine).
2. Programmatic errors Septic – toxic shock
syndrome and abscess.
Interaction between indigenous and prescription
drugs:
Use of indigenous drugs is neither inquired in the drug
history nor are the patients advised to avoid such an
indiscriminate concurrent use of drugs. Sometimes these
factors lead to either a therapeutic failure or a drug
interaction or an accentuation of the unknown toxicities
of the chemical prescription drugs [25].
Ophthalmological complications [5]
1. Cataract Busulphan
2. Corneal opacities Chloroquine
5. MJAFI, Vol. 61, No. 1, 2005
6 Krishnan and Kasthuri
3. Colour vision alteration Digitalis
4. Glaucoma Sympathomimetics
5. Optic neuritis Quinine
6. Retinopathy Chloroquine
Radiation hazards [5]
1. Acute and chronic progressive radiation injuries
2. Pneumonitis
3. Glomerulosclerosisandchronicinterstitialnephropathy
4. Enteritis and cystitis
5. Venoocclusive disease of liver
6. Bone marrow depression
7. Malignancy
Hazards of hospitalization
The prevalence of hospital-acquired infections is
around 10%. Urinary tract infections and respiratory
infections are the commonest. There is increased chance
of infections associated with diagnostic and therapeutic
procedures and with antibiotic resistant bacterial flora
[26].
Physician as the cause of the disease
The harm that a physician can do is not limited to the
imprudent use of medicine or procedure, but may include
unjustified remarks and misinterpretation of
investigational data. The physician should be aware of
the properties of drugs that he prescribes and their
potential dangers. Ignorance of the possibility of a
reaction is a clear evidence of negligence. The physician
should warn the patient of the likely side effects [1,27].
The list of drugs given in this article is in no way
complete and only examples are given. Readers should
look up the references to have more details. Drugs
affecting the fetus or breastfed babies are not discussed.
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